Oh Baby! OB Coding for ICD-10-PCS

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Program Handouts Tuesday, June 9, 2015 Track One 1:00pm – 2:00pm 2015 State Convention and Exhibit

Speaker Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10 Trainer

California Health Information Association

Oh Baby! OB Coding for ICD‐10‐PCS June 9, 2015

Kristi Pollard, RHIT, CCS, CPC, CIRCC Senior Coding Consultant AHIMA‐Approved ICD‐10‐CM/PCS Trainer Haugen Consulting Group [email protected]

Disclaimer

• This material is designed and provided to communicate information about clinical documentation,,g, coding, and compliance in an educational format and manner. • The author is not providing or offering legal advice but, rather, practical and useful information and tools to achieve compliant results in the area of clinical documentation, data quality, and coding. • Every reasonable effort has been taken to ensure that the educational information provided is accurate and useful. • Applying best practice solutions and achieving results will vary in each hospital/facility and clinical situation.

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Goals/Objectives

• Differentiate between Medical and Surgical and Obstetrical sections of ICD‐10‐PCS when coding for pregnancy‐related procedures • Determine the body system and body part for coding obstetrical laceration repairs • Utilize Coding Clinic advice for coding obstetrical cases • Distinguish between the Extraction tables in the Medical and Surgical and Obstetrics sections

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Three Variations of POC

Products of Conception

•Viable pregnancy

Products of Conception, Ectopic

•Displaced pregnancy

Products of Conception, Retained

•Nonviable pregnancy (e.g., spontaneous or missed abortion • Postpartum retention of POC

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OB Procedures on Products of Conception

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Guideline C1

“d“Procedures perfdformed on the pro ducts o f conception are coded to the Obstetrics section. Procedures performed on the pregnant female other than the products of conception are coded to the appro priate root operation in the Medical and Surgical section.”

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OB Procedures

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Delivery • Two possible root operations – Delivery • “Catching the baby” – Extraction • Cesarean delivery Extraction has multiple uses… Not just delivery of • Vacuum extraction the infant! • Forceps extraction • Breech extraction – With or without internal version

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DRG Alert! A delivery code from the OB section (10D/10E) must be coded to generate an delivery MS‐DRG!

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Delivery (10E)

The table with only one code!

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Cesarean Section (10D)

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Vacuum‐Assisted C‐Section • Coding Clinic, 4th Quarter 2014, page 43: – Vacuum extraction to assist cesarean section is included in cesarean section code. The vacuum assistance is not separately coded

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Other Assisted Delivery (10D)

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Qualifiers for Other Assisted Delivery • Forceps delivery (3, 4, 5) – Qualifier specifies level ((,low, mid, high) – Not used for rotation of fetal Low Forceps Mid Forceps head without forceps delivery • Rotation of fetal head only = Reposition (10S07ZZ) • Vacuum extraction (()6) • Breech extraction – With internal version (7) Vacuum Extraction ©2015 Haugen Consulting Group, Inc. – Without internal version (8)

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Episiotomy (0W8)

Index Listing: Episiotomy ‐ see Division, Perineum, Female 0W8N Don’t code repair of episiotomy Do code repair of laceration that is an extension of an episiotomy 0W8NXZZ

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Obstetrical Lacerations • Code to the structure(s) involved • Remember the guideline for overlapping structures B3.5 “If the root operations Excision, Repair or Inspection are perfdformed on overlliapping layers of the musculoskeletal system, the body part specifying the deepest layer is coded.”

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Obstetrical Lacerations Lots of Coding Clinic advice! • Fourth Quarter 2013, page 120 – Open approach is used for 2° laceration repair because the laceration has exposed the muscle • Fourth Quarter 2014, page 43 – By ddfiitiefinition, a 2° OB ltilaceration involves the muscle of the perineum • Code to the body part Perineum, Muscle

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First Degree Laceration Repair • Repair of skin of perineum • Build the code – Section = Medical and Surgical (0) – Body System = Skin and Breast (H) – Root operation = Repair (Q) – Body Part = Skin, Perineum (()9)

– Approach = External (X) 0HQ9XZZ – Device = No Device (Z) Repair Perineum Skin, External Approach – Qualifier = No Qualifier (Z)

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Second Degree Laceration • Repair of skin and muscle of the perineum • Remember guideline B3.5 – Build the code • Section = Medical and Surgical (0) • Body System = Muscles (deepest perineal layer) (K) • Root operation = Repair (Q) • BdBody Part = MlMuscle, PiPerineum (M) • Approach = Open (0) 0KQM0ZZ • Repair Perineum Muscle, Device = No Device (Z) Open Approach • Qualifier = No Qualifier (Z)

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Third Degree Laceration • Repair of 2 different body systems – Muscles • Perineal muscle (deepest layer of perineum) – Gastrointestinal System • Anal sphincter

2 body systems = 2 codes

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Third Degree Laceration –First Code

• Build the code – Build the code • Section = Medical and Surgical (0) • Body System = Muscles (deepest perineal layer) (K) • Root operation = Repair (Q) • Body Part = Muscle, Perineum (M) • Approach = Open (0)

• Device = No Device (Z) 0KQM0ZZ • Qualifier = No Qualifier (Z) Repair Perineum Muscle, Open Approach

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Third Degree Laceration –Second Code • Build the code – Section = Medical and Surgical (0) – Body System = Gastrointestinal System (D) – Root operation = Repair (Q) – Body Part = Anal Sphincter (R) – Approach = Open (0) – Device = No Device (Z) 0DQR0ZZ – Qualifier = No Qualifier (Z) Repair Anal Sphincter, Open Approach

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Fourth Degree Laceration • Repair of 2 different body systems – Muscles • Perineal muscle (deepest layer of perineum) – Gastrointestinal System • Documentation should specify structures repaired – Anal sphincter – Rectum – Anus • Remember! – Guideline B3.5 applies to the musculoskeletal system, not GI

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Fourth Degree Laceration –First Code

• Build the code – Section = Medical and Surgical (0) – Body System = Muscles (deepest perineal layer) (K) – Root operation = Repair (Q) – Body Part = Muscle, Perineum (M) – Approach = Open (0) – Device = No Device (Z) 0KQM0ZZ – Qualifier = No Qualifier (Z) Repair Perineum Muscle, Open Approach

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Fourth Degree Laceration – Additional Codes • Build the code – Section = Medical and Surgical ()(0) – Body System = Gastrointestinal System (D) – Root operation = Repair (Q) Specific code(s) depend on – Body Part(s) documentation of repaired • Anal Sphincter (R) structures • Rectum (P) 0DQR0ZZ Repair Anal S phincter, O pen • Anus (Q) Approach – Approach = Open (0) 0DQP0ZZ – Device = No Device (Z) Repair Rectum, Open Approach 0DQQ0ZZ – Qualifier = No Qualifier (Z) Repair Anus, Open Approach

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Other OB Laceration Repairs

• Coding Clinic References – Fourth Quarter 2014, page 43 • Periurethral laceration – “peri” guideline does not apply here – Body part = vulva – Fourth Q,Quarter 2013, pgpage 120 • Clitoral laceration = Repair of clitoris

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Other OB Lacerations • Build the code – Section = Medical and Surgical (0) – Body System = Female Reproductive System (U) – Root operation = Repair (Q) – Body Part(s) • Vulva (periurethral) (M) • Clitoris (J) • Hymen (K) • ViVagina (G) Periurethral Repair – Approach = External (X) 0UQMXZZ Repair Vulva, External – Device = No Device (Z) Approach – Qualifier = No Qualifier (Z)

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Pitocin Administration • Coding Clinic, Second Quarter 2014 – Don’t Code Pitocin augmentation • Do Code Pitocin induction – Must know route of administration (e.g., peripheral vein) – Substance = Hormone – Qualifier = Other Hormone – 3E033VJ, Introduction of Other Hormone into Peripheral Vein, Percutaneous Approach

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Cervidil/Cytotec Administration • Coding Clinic, Second Quarter 2014 – 3E0P7GC, Introduction of other therapeutic substance into female reproductive, via natural or artificial opening

3E0P7GC groups to a surgical MS‐DRG!

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Artificial Rupture of Membranes • Procedure intent: rupture membranes prior to delivery • Build the code 10907ZC Drainage of Amniotic Fluid, – Section = Obstetrics (1) Therapeutic from POC, Via – Body System = Pregnancy (0) Opening – Root Operation = Drainage (9) – Body Part = Products of Conception (amniotic fluid is part of POC) (0) – Approach = Via Natural or Artificial Opening (most likely) (7) – Device = No Device (Z) – Qualifier = Amniotic Fluid, Therapeutic (C)

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Amniocentesis • Procedure intent: drain fluid via needle from amniotic sac for diagnostic or therapeutic purposes • Bu ild the code – Section = Obstetrics (1) – Body System = Pregnancy (0) – Root Operation = Drainage (9) – Body Part = Products of Conception (amniotic fluid is part of POC) (0) – Approach • Percutaneous (3) – Device = No Device (Z) – Qualifier ©2015 Haugen Consulting Group, Inc. • Amniotic Fluid, Diagnostic (U) • Amniotic Fluid, Therapeutic (C)

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Fetal Monitoring

Internal Fetal Monitoring External Fetal Monitoring

• Electrode placed internally • Electrode placed externally (e.g., scalp electrode) • Fetal monitoring • Two codes: – 10H073Z, Insertion of – 4A1HXCZ, Monitoring of monitoring electrode into products of conception, products of conception, via cardiac rate, external approach natural or artificial opening – 4A1H7CZ, Monitoring of products of conception, cardiac rate, via natural or artificial opening

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Intrauterine Fetal Surgery • Two root operations for procedures performed on the fetus in utero – Drainage (9) • Fetal blood (9) • Fetal Cerebrospinal Fluid (A) • Fetal Fluid, Other (B) – Repair (Q) ©2015 Haugen Consulting Group, Inc. • Repair of fetal defects in utero • Qualifier specifies the fetal body system operated on – e.g., intrauterine repair of spina bifida (neural tube defect) – 10Q08ZE, Repair nervous system in products of conception, via natural or artificial opening endoscopic

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Other OB Procedures

Retained PP POC

DUB D&C MAB/SAB

Abortion

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Guideline C2 “Procedures performed following a delivery or abortion for curettage of the endometrium or evacuation of retained products of conception are all coded in the Obstetrics section, to the root operation Extraction and the body part Products of Conception, Retained.

Diagnostic or therapeutic dilation and curettage performed during times other than the postpartum or post‐abortion period are all coded in the Medical and Surgical section, to the root operation Extraction and the body part Endometrium.”

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D&C – Choosing the Right Section D&C of POC? No Yes

Medical & Surgical To abort pregnancy?

Extraction ‐ Yes No endometrium

Extraction –POC, Abortion –POC retained

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Abortion vs. Extraction of Retained POC

Procedure Intent Root Body Part Operation To treat missed or incomplete Extraction Products of spontaneous abortion Conception, Retained (miscarriage)

To terminate pregnancy Abortion Products of (induced abortion) Conception

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10D17ZZ Extraction of products of POC Extraction conception, retained, via natural or artificial • opening Building the code 10D18ZZ – Section = Obstetrics (1) Extraction of products of conception, retained, via – Body System = Pregnancy (0) natural or artificial – Root Operation = Extraction (D) opening endoscopic – Body Part = Products of Conception, Retained (1) – Approach • Via Natural or Artificial Opening (7) • Via Natural or Artificial Opening Endoscopic (8) – Device = No Device (Z) – Qualifier = No Qualifier (Z)

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Coding Clinic References • Coding Clinic, Second Quarter, 2014, page 43: – D&C for removal of a blighted ovum using vacuum D&C is coddded as EiExtraction of prod ucts o f concepti on wiihth the Qualifier Vacuum: – 10D07Z6, Extraction of products of conception, vacuum, via natural or artificial opening

• Coding Clinic, Second Quarter 2013, page 38: – Post‐partum evacuation of a bl oo d cl ot i s coddded to the Medical and Surgical section and root operation Extirpation: – 0UC97ZZ, Extirpation of matter from uterus, via natural or artificial opening

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Abortion

Do Not use Abortion to code treatment of a miscarriage!

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Removal of Ectopic Pregnancy • Procedure Intent: completely remove retained products of conception • Build the code – Section = Obstetrics (1) – Body System = Pregnancy (0) – Root Operation = Resection (T) – Body Part = Products of Conception, Ectopic (2) – Approach • Open (0) • Percutaneous (3) • Percutaneous Endoscopic (4) ©2015 Haugen Consulting Group, Inc. • Via Natural or Artificial Opening (7) • Via Natural or Artificial Opening, Endoscopic (8) – Device = No Device (Z) – Qualifier = No Qualifier (Z)

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Summary

• Products of conception = any structure or fluid that results from egg fertilization • Procedures performed on POC code to the Obstetrical section; procedures performed on the mother code to the Medical and Surgical section • Two root operations for delivery of an infant: Delivery and Extraction • Episiotomy and obstetrical laceration repairs code to the Medical and Surgical section • Remember Coding Clinic advice for OB laceration repairs! • AROM and amniocentesis code to Drainage of POC • D&C codes to Medical and Surgical or Obstetrical section, depending on tissue removed • Root operation Abortion is for termination of pregnancy only!

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Questions?

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Bibliography

• 2015 ICD‐10‐PCS Code Set and Guidelines: http: //www.cms.gov/Me dicare /Co ding /ICD10 /2015‐ICD‐10‐PCS‐and‐GEMs.html • Coding Clinic for ICD‐10‐CM/PCS, American Hospital Association, Fourth Quarter 2012‐ First Quarter 2015

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